Examining asthma quality of care using a population-based approach
Examining asthma quality of care using a population-based approach
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DOI：
10.1503/cmaj.070426
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发表时间：
2008-04-08
影响因子：
14.6
通讯作者：
Jorgenson, Derek
中科院分区：
文献类型：
--
作者：
Klomp, Helena;Lawson, Joshua A.;Jorgenson, Derek
背景：哮喘对卫生保健造成相当大的负担，但在大多数情况下，哮喘是可以控制的。医疗质量指标将有助于监测哮喘管理。我们使用一组建议的质量指标来描述哮喘护理的质量。方法：我们利用加拿大萨斯喀彻温省的健康数据库进行了一项回顾性横断面研究，萨斯喀彻温省人口约100万。我们评估了哮喘患者的6项护理质量指标：因哮喘入院；哮喘控制不良（大量使用短效β激动剂，因哮喘住院或因哮喘死亡）；控制不良的患者未使用吸入性皮质类固醇；控制不良的患者至少适度使用吸入性皮质类固醇；在控制不良的患者中大量吸入皮质类固醇和使用另一种预防药物；以及在控制不良的患者中使用任何主要预防药物。我们以95%的置信区间计算粗率和调整率。我们使用chi(2)比例检验和广义线性建模技术来检验差异。结果：2002/03年度，萨斯喀彻温省有24 616名5-54岁哮喘患者，患病率为3.8%。18%的哮喘患者症状控制不佳。在控制不良的患者中，37%的患者没有使用任何吸入性皮质类固醇，40%的患者使用的剂量可能不足。在那些使用了大剂量吸入性皮质类固醇的控制不佳的患者中，26%还使用了另一种预防药物。6-9岁和20-44岁的女性因哮喘入院的比例最高。男性和成年年龄组（主要是20-44岁）的4项指标的护理质量较差。解释：通过增加吸入皮质类固醇和预防药物的使用，以及减少对共识指南推荐的短效β受体激动剂药物的依赖，可以改善次优哮喘管理。
Background: Asthma accounts for considerable burden on health care, but in most cases, asthma can be controlled. Quality-of-care indicators would aid in monitoring asthma management. We describe the quality of asthma care using a set of proposed quality indicators.Methods: We performed a retrospective cross-sectional study using health databases in Saskatchewan, a Canadian province with a population of about 1 million people. We assessed 6 quality-of-care indicators among people with asthma: admission to hospital because of asthma; poor asthma control (high use of short-acting beta-agonists, admission to hospital because of asthma or death due to asthma); no inhaled corticosteroid use among patients with poor control; at least moderate inhaled corticosteroid use among patients with poor control; high inhaled corticosteroid use and use of another preventer medication among patients with poor control; and any main preventer use among patients with poor control. We calculated crude and adjusted rates with 95% confidence intervals. We tested for differences using the chi(2) test for proportions and generalized linear modelling techniques.Results: In 2002/03, there were 24 616 people aged 5-54 years with asthma in Saskatchewan, representing a prevalence of 3.8%. Poor symptom control was observed in 18% of patients with asthma. Among those with poor control, 37% were not dispensed any inhaled corticosteroids, and 40% received potentially inadequate doses. Among those with poor control who were dispensed high doses of inhaled corticosteroids, 26% also used another preventer medication. Hospital admissions because of asthma were highest among those aged 6-9 years and females aged 20-44 years. Males and those in adult age groups (predominantly 20-44 years) had worse quality of care for 4 indicators examined.Interpretation: Suboptimal asthma management would be improved through increased use of inhaled corticosteroids and preventer medications, and reduced reliance on short-acting beta-agonist medications as recommended by consensus guidelines.